America’s Role in Sex Selection

By Prof. Jaime S. King, Hastings College of Law, Non-Resident Fellow, Center for Law and the Biosciences:

Last week, HRC Fertility, a leading fertility clinic on the West Coast, announced its new educational website – www.gender-baby.com – aimed at helping hopeful parents choose the sex of their child – for medical or personal reasons.

When performed for medical purposes, sex selection has generally been considered ethically appropriate. Physicians offer patients with a family history of an X-linked genetic disorder information on the sex of the fetus or preimplantation embryo to enable them to select against male fetuses who would have a 50% chance of having the disorder. However, in many countries, the technologies that enable sex selection for medical purposes have been quickly adopted for other uses – including family balancing (selecting a boy when the parents already had a girl and vice versa) and parental preference. The use of medical technology, including ultrasound, amniocentesis, sperm sorting, or even preimplantation genetic diagnosis (PGD), for non-medical sex selection has been more controversial. For many, non-medical sex selection seems to simultaneously support the drive toward “designer babies” and emphasize the relevance of the differences between the sexes.

But let’s face facts – as the HRC website makes sure to point out – sex selection for social purposes has been occurring for centuries. Globally, it’s not a new phenomenon. And its use by ART clinics in America is also not new. A survey of U.S. ART clinics published by the Genetics and Public Policy Center in 2006 found that 39% were willing to provide non-medical sex selection in the absence of another reason to undergo PGD, and just under 10% of the PGD procedures performed in the surveyed clinics were for non-medical sex selection. So what makes HRC Fertility’s new website worthy of consideration?

Two things really.

First, HRC Fertility takes a clear stance in favor of patients opting for non-medical sex selection as a valid exercise of their reproductive autonomy. It provides numerous justifications for why parents might choose to engage in non-medical sex selection. One consistent theme is the idea that parents in today’s society have smaller families and want the ability to parent children of both sexes. HRC Fertility has the technology to help them do just that. All parents must do is undergo IVF and PGD (which are expensive, carry significant risks for the mother, and are largely unpleasant (again for the mother)) – but it’s worth it to get the perfect child you want, right?

In many places the website purports to acknowledge both sides of the debate over sex selection by posting references to consensus statements by professional societies or non-profit organizations that oppose non-medical sex selection. But, these statements are then followed up by comments that subtly and not so subtly refute these recommendations in a presumed effort to make potential patients still feel comfortable having sex selection. For instance, HRC Fertility’s website acknowledges the guidelines issued by the Ethics Committee of the American College of Obstetricians and Gynecologists (ACOG), which counsel strongly against non-medical sex selection, “because they may ultimately support sexist practices.” The website’s Ethical, Moral and Social Issues Section references the ACOG guidance, but then immediately dismisses it through a quote by Dr. Daniel A. Potter, an ACOG fellow, stating:

“ACOG purports to support a woman’s right to reproductive autonomy, including abortion for any reason…. To oppose family balancing because it ‘may’ support sexist practices is absurd. … The issue here is reproductive autonomy … a decision that should be made privately by the patient and her physician.”

Did I mention Daniel A. Potter works at HRC? Yup. He’s one of the eleven physicians they have on staff.

It was only a matter of time before Fertility Clinics in the U.S. stopped quietly ignoring professional society guidelines and started blatantly disregarding them. Too much money is potentially on the table from both domestic and international wannabe parents. HRC Fertility’s website demonstrates the overall ineffectiveness of professional standards as a method of regulating the assisted reproduction and reproductive genetic testing, and offers a strong incentive to consider regulating the practice of ART in the U.S.

The second striking feature of the website is its clearly stated willingness to offer sex selection services to women from countries with high male to female ratios where sex selection is prohibited. In response to an anonymous question regarding whether HRC will take patients from countries where sex selection is illegal, Dr. Tourgeman states:

“Gender selection is legal in the United States. Living in a country where gender selection is not legal does not preclude you from becoming an HRC patient and making use of our advanced technology. In addition, HRC is very adept at finding and working with physicians and fertility clinics in your country so that you can be monitored close to home.”

The website openly discusses the historical preference for boys and offers explanations of “Why Men want Sons” and “Why Women want Daughters.” Overall, the website seems to generally support the use non-medical sex selection to ensure the birth of a son, even when based on cultural biases favoring males.

It is time for America to examine the issues and take a stance on sex selection. And let’s be clear – not doing anything is a policy decision. What role do we want to play in the future of sex selection? Moreover, what role do we want to play in the burgeoning field of reproductive genetic selection? Do we want to be the global destination for parents who want a boy in spite of the societal harms beginning to develop in countries with high male to female ratios in their home country? What about at home? Do we think that non-medical sex selection is an appropriate exercise of reproductive autonomy, which should be protected by the 14th Amendment – or do we feel that the ability to determine the sex of a child does not rise to the level of importance of a constitutionally protected decision, such that a state could regulate the practice? How do we feel about other genetic conditions and characteristics?

Prenatal Specialist

hgreely

December 5, 2011 at 9:56 am

WARNING ABOUT THE NEXT COMMENT.

It is a commercial advertisement for something that appears, on first glance at least, to be quackery – a non-technological set of methods for intercourse that it claims can determine the sex of any resulting fetus. And if you follow their link, you get on a page that is not entirely easy to get off of.

It has amazed me how many “spam comments” this blog attracts. I probably mark an average of five submitted comments a day as spam. Usually they have some innocuous (though often not quite right) message and a sender name or URL that show some, probably disreputable, commercial intent. Here’s an example of a “comment” sought to be added to a post about schizophrenia:

That is the suitable weblog for anybody who desires to search out out about this topic. You realize so much its nearly onerous to argue with you (not that I truly would needHaHa). You undoubtedly put a brand new spin on a subject thats been written about for years. Nice stuff, just nice!

This is similarly commercial spam, but I think some readers might find it useful as an example of what’s out there in terms of sex selection – and, apparently, in terms of parental eagerness to engage in sex selection. But my allowing the comment to go up should NOT be read as any endorsement of their method – or of commercially driven, spam comments on blogs!

Espet

January 24, 2012 at 9:53 am

What an interesting article that can cause a good debate. The importance of sex selection should be decided by the parents to be and not the government or by certain laws. Future parents should decide for themselves whether sex selection is ethical or not. THere are so many all-natural ways to choose the gender of your baby whether it is for medical reasons or not.

Aiping Wang

February 3, 2012 at 6:26 pm

This is such a very informative article. I believe that the parents are the one responsible on choosing or deciding for the right sex. up to now many are still debating regarding this issue. That’s why I’m very thankful for your post. you did clear some of my questions in mind.

gender selection

May 12, 2014 at 12:10 pm

This is a controversial issue that will be heavily debated for some time to come. The issue of people choosing boys over girls is a key issue in these debates. There is, rightly, concern that boys ae given preference over girls in some cultures and this is ethically and morally wrong. That is agreed. But when it comes to these debates, most people miss the point that in many of these cultures, if the preferred gender is not conceived and the parents feel strongly about it, this often leads to one of two outcomes 1. the mother either aborts a healthy child, or 2. the child is born but only to potentially live a life of misery and ill treatment.

Now in my opinion gender selection is not bad alternative to mothers forcing to abort for a preferred gender or an ill treated child. Does it not solve this problem?